Staring down acne: adult acne is on the rise, and its effects can be painful and demoralizing. Here are 45 strategies to help you break free of breakouts

Natural Health, June, 2005 by R. Daniel Foster

YO, HAS YOUR FACE gone, like, totally retro? Is your skin a zit pit? Acne isn't just for teenagers anymore--and there's a special misery to breaking out when you're 37 and fretting about crow's-feet. "The vast majority of people once outgrew adolescent ache, except for an unlucky few," says Richard Fried, M.D., a dermatologist and clinical psychologist in Yardley, Pa., and author of Healing Adult Ache. "Now about half of adults deal with ache in some form, and many who never had significant ache develop it for the first time."

So what's responsible for the jump in grown-up ache? Pollution, new medications, and hormone-fed meats are among the irritants cited. "The one common denominator we see among adult ache patients, however, is stress," says Linda K. Franks, M.D., assistant clinical professor of dermatology at New York University School of Medicine. "People are juggling work and family, and generally have busier lives."

Women get the worst of it: About 54 percent of adult females are afflicted with ache, compared to 40 percent of adult males. Chalk up the difference to age-related hormonal changes (which are exacerbated by stress), more oil production, birth-control use, pregnancy, stress, and menopause.

To add inconvenience to injury, the pimples may act the same, but the skin does not. Drier and less resilient, an adult woman's skin can be easily damaged by some of the treatments she may have relied on during her adolescence.

taking root

ALL ACNE ORIGINATES in hair follicles, which either become inflamed and produce pimples, or plug up with whiteheads and blackheads. Male hormones called androgens (present in both genders) trigger ache by raising levels of sebum, or oil, produced by sebaceous glands at the base of these follicles. Hair is normally softened and lubricated by oil, but excess amounts paired with dead-skin-cell buildup cause blockage. When bacteria are present, the follicle becomes irritated, forming pustules.

Some people simply produce more sebum and have greater numbers of sebaceous glands. Others have a poorer rate of skin-cell turnover and are more sensitive to hormones. And ache is partly tied to genes: If your parents battled ache, odds are, so do you.

Only 7 percent to 14 percent of adults suffer from chronic, "clinically significant" acne. Yet even sporadic outbreaks have a high emotional cost. "Studies show that a person can be as profoundly depressed with one zit on her chin a month as someone with a face full of acne," says Fried. "We've seen women who feel burdened, imperfect, and unattractive in their 40s and 50s because of acne, and data show that those with ache suffer from higher rates of divorce, unemployment, suicide, and sexual dysfunction. Acne is not trivial."

The most common form of acne is ache vulgaris, but there are other types caused by irritants such as heat and humidity or exposure to certain pesticides. In the worst cases, cysts can form deep beneath the skin and result in scarring.

Nancy, a 45-year-old medical biller from Massachusetts, had to cope with painful cystic ache throughout her teens and 20s. She went on and off oral antibiotics, which slow bacteria growth. "But it never permanently went away," she says.

At 29, she enrolled in a six-month plan of supplements and balanced meals devised by Georgianna Donadio, Ph.D., founder and program director of the National Institute of Whole Health. "After six months," Nancy says, "I was pulling the hair away from my face for the first time, and people were saying how much my complexion had improved."

the food factor

"A POOR DIET really affects the liver," says Donadio. "The liver dampens and tempers the intensity of androgen hormones, which trigger oil production in the sebaceous glands."

While a 1969 landmark study seemed to prove there is no causal link between diet and acne, a 2002 study at Colorado State University suggested that a diet high in refined carbohydrates boosts insulin, which elevates hormones and stimulates sebaceous glands. Investigators noted that islanders in Papua New Guinea and Paraguay, whose diets were similar only in that they were free of typical Western refined carbs, remained untroubled by acne.

The research isn't conclusive, yet many dermatologists won't argue with those who peg outbreaks to diet. "When a patient comes in and says, 'Every time I eat peanut M&Ms, I break out,' I tell them to stay away from that particular food," says Tina Alster, M.D., director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C.

For a proactive approach, add flaxseeds to your diet. They contain lignans, phytoestrogens that are believed to stabilize a woman's ratio of estrogen and progesterone. Flaxseeds also contain essential fatty acids, which have anti-inflammatory actions, among other benefits.

The recommended daily dose of lignans varies per person, though a rounded tablespoon of ground flaxseeds is commonly prescribed. (Some flaxseed oils lack the lignans component, so check labels and look for certified flaxseed.) A standardized lignans extract now exists, and is used in products like Jarrow Formulas Flax Essence, Nature's Life Golden Flaxseed Lignans, Spectrum Organic Enriched Flax Oil, and Swanson Health Products LinumLife High Lignan Complex.